Individual
MARYANN B BLEVINS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
3525 S NATIONAL AVE, #105, SPRINGFIELD, MO 65807-7310
(417) 840-0802
(417) 269-1098
Mailing address
PO BOX 4046, SPRINGFIELD, MO 65808-4046
(417) 269-5712
(417) 269-7567
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
083185
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
181509
BLUE CROSS OF MO
—
05
—
428408405
—
MO
Enumeration date
09/20/2006
Last updated
08/07/2019
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